First Alaskapox death reported, officials say residents ‘shouldn’t be overly concerned’

February 16, 2024

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Key takeaways:

• Seven cases of Alaskapox and one death have been reported in Alaksa since 2015.
• Officials are not certain how it spreads from animals to people but said that no human-to-human transmission has been reported.

Health officials in Alaska have reported the first-ever death from Alaskapox, and although the disease may be wider spread than previously believed, experts say there is no evidence of risk outside of Alaska.

On Feb. 9, the Alaska Department of Health reported the first death caused by Alaskapox — an orthopoxvirus that can be transmitted from animals to humans. The case was an elderly man from the Kenai Peninsula with a history of drug-induced immunosuppression secondary to cancer treatment.

Data derived from Alaska Department of Health.

According to the agency, the man noticed a tender, red papule in his right axilla, which was biopsied and found to be negative for malignancy or bacterial infection. Despite antibiotic therapy, he experienced fatigue and pain and was ultimately hospitalized in November.

Four additional pox-like lesions were discovered across his body, leading to hospital testing, which initially reported the lesions as positive for cowpox in December.

However, a lesion swab sent to the Alaska State Public Health Laboratory tested positive on a generic orthopoxvirus PCR assay and negative on a non-variola orthopoxvirus PCR assay, ruling out cowpox, mpox, and vaccinia viruses. Additional CDC testing was positive for Alaskapox virus.

The man died in late January.

This was the seventh case of Alaskapox reported since the virus was first identified in Fairbanks, Alaska in 2015. Since the first case, five additional cases were reported in Fairbanks as of December 2023. The most recent case, however, marks the first infection identified outside of the Fairbanks area.

“Our investigation indicates that Alaskapox virus appears to be more widely present in small mammals in Alaska than previously known, rather than confined to the Fairbanks area,” Julia Rogers, PhD, MPH, Epidemic Intelligence Service officer for the CDC assigned to the Alaska Department of Health, told Healio.

“We are not sure exactly how the virus spreads from animals to people, but direct contact with infected small mammals and exposure to domestic pets that have had contact with small mammals are both likely sources, similar to other orthopoxviruses,” she said.

Rodgers said that the extent to which Alaskapox virus is enzootic in small mammals is currently under investigation. Through two rounds of small mammal sampling conducted in 2020 and 2021, however, several species of small mammals have shown evidence of current or prior Alaskapox virus infection in the Fairbanks North Star Borough, including red-backed voles, shrews, red squirrels, and flying squirrels.

Although health officials have not publicly reported any investigation of animals in connection with the most recent case, the man who died reported caring for a stray cat at his residence that “regularly hunted small mammals” and frequently scratched him.

Rodgers added that, so far, there is no evidence of Alaskapox virus being passed from person to person based on the seven case investigations that have been conducted. The potential for person-to-person transmission, however, “cannot be excluded” based on what is known about other orthopoxviruses, she said, especially if a person with broken or cracked skin comes into contact with secretions from a rash in a patient who has Alaskapox.

“Because Alaskapox is a rare illness, Alaskans shouldn’t be overly concerned about this virus. However, they should be aware of the signs and symptoms and consult a health care provider if they have a suspicious rash,” Joseph McLaughlin, MD, MPH, chief epidemiologist at the State of Alaska Department of Health, told Healio.

McLaughlin explained that signs and symptoms include one or more skin bumps that gradually become filled with puss, along with skin redness around the bump(s), fever, swollen lymph nodes and joint or muscle pain.

Several of the previous patients with Alaskapox, he noted, initially thought they had a spider or insect bite and that all but one had relatively mild illnesses that resolved on their own after several weeks.

He added, “There is no evidence at this time that people outside of Alaska are at risk for Alaskapox.”

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